This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Lodise, T. P.
Right arrow Articles by Stellrecht, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Lodise, T. P.
Right arrow Articles by Stellrecht, K.

 Previous Article  |  Next Article 

Antimicrobial Agents and Chemotherapy, September 2008, p. 3315-3320, Vol. 52, No. 9
0066-4804/08/$08.00+0     doi:10.1128/AAC.00113-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Relationship between Vancomycin MIC and Failure among Patients with Methicillin-Resistant Staphylococcus aureus Bacteremia Treated with Vancomycin{triangledown}

T. P. Lodise,1,2* J. Graves,1 A. Evans,3 E. Graffunder,4 M. Helmecke,4 B. M. Lomaestro,5 and K. Stellrecht3

Albany College of Pharmacy, Pharmacy Practice Department, Albany, New York,1 Ordway Research Institute, Albany, New York,2 Albany Medical Center Hospital, Department of Pathology and Laboratory Medicine, Albany, New York,3 Albany Medical Center Hospital, Department of Epidemiology, Albany, New York,4 Albany Medical Center Hospital, Department of Pharmacy, Albany, New York5

Received 25 January 2008/ Returned for modification 20 March 2008/ Accepted 23 June 2008

There is growing concern that vancomycin has diminished activity for methicillin-resistant Staphylococcus aureus (MRSA) infections, with vancomycin MICs at the high end of the CLSI susceptibility range. Despite this growing concern, there are limited clinical data to support this notion. To better elucidate this, a retrospective cohort study was conducted among patients with MRSA bloodstream infections who were treated with vancomycin between January 2005 and May 2007. The inclusion criteria were as follows: at least 18 years old, nonneutropenic, with an MRSA culture that met the CDC criteria for bloodstream infection, had received vancomycin therapy within 48 h of the index blood culture, and survived >24 h after vancomycin administration. Failure was defined as 30-day mortality, bacteremia ≥10 days on vancomycin therapy, or a recurrence of MRSA bacteremia within 60 days of vancomycin discontinuation. Classification and regression tree (CART) analysis identified the vancomycin MIC breakpoint associated with an increased probability of failure. During the study period, 92 patients met the inclusion criteria. The vancomycin MIC breakpoint derived by CART analysis was ≥1.5 mg/liter. The 66 patients with vancomycin MICs of ≥1.5 mg/liter had a 2.4-fold increase in failure compared to patients with MICs of ≤1.0 mg/liter (36.4% and 15.4%, respectively; P = 0.049). In the Poisson regression, a vancomycin MIC of ≥1.5 mg/liter was independently associated with failure (adjusted risk ratio, 2.6; 95% confidence interval, 1.3 to 5.4; P = 0.01). These data strongly suggest that patients with MRSA bloodstream infections with vancomycin MICs of ≥1.5 mg/liter respond poorly to vancomycin. Alternative anti-MRSA therapies should be considered for these patients.

* Corresponding author. Mailing address: Albany College of Pharmacy, Department of Pharmacy Practice, 106 New Scotland Avenue, Albany, NY 12208-3492. Phone: (518) 445-7292. Fax: (518) 518-694-7062. E-mail: lodiset{at}acp.edu

{triangledown} Published ahead of print on 30 June 2008.

Antimicrobial Agents and Chemotherapy, September 2008, p. 3315-3320, Vol. 52, No. 9
0066-4804/08/$08.00+0     doi:10.1128/AAC.00113-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Patel, N., Lubanski, P., Ferro, S., Bonafede, M., Harrington, S., Evans, A., Stellrecht, K., Lodise, T. P. (2009). Correlation between Vancomycin MIC Values and Those of Other Agents against Gram-Positive Bacteria among Patients with Bloodstream Infections Caused by Methicillin-Resistant Staphylococcus aureus. Antimicrob. Agents Chemother. 53: 5141-5144 [Abstract] [Full Text]  
  • Kuper, K. M., Hirsch, E. B., Tam, V. H., on behalf of the Houston Infectious Diseases Netwo, (2009). Significant publications on infectious diseases pharmacotherapy in 2008. Am J Health Syst Pharm 66: 1726-1734 [Abstract] [Full Text]  
  • Svetitsky, S., Leibovici, L., Paul, M. (2009). Comparative Efficacy and Safety of Vancomycin versus Teicoplanin: Systematic Review and Meta-Analysis. Antimicrob. Agents Chemother. 53: 4069-4079 [Abstract] [Full Text]  
  • LaPlante, K. L., Woodmansee, S. (2009). Activities of Daptomycin and Vancomycin Alone and in Combination with Rifampin and Gentamicin against Biofilm-Forming Methicillin-Resistant Staphylococcus aureus Isolates in an Experimental Model of Endocarditis. Antimicrob. Agents Chemother. 53: 3880-3886 [Abstract] [Full Text]  
  • Naesens, R., Ronsyn, M., Druwe, P., Denis, O., Ieven, M., Jeurissen, A. (2009). Central nervous system invasion by community-acquired meticillin-resistant Staphylococcus aureus. J Med Microbiol 58: 1247-1251 [Abstract] [Full Text]  
  • Leonard, S. N., Vidaillac, C., Rybak, M. J. (2009). Activity of Telavancin against Staphylococcus aureus Strains with Various Vancomycin Susceptibilities in an In Vitro Pharmacokinetic/Pharmacodynamic Model with Simulated Endocardial Vegetations. Antimicrob. Agents Chemother. 53: 2928-2933 [Abstract] [Full Text]  
  • Moise, P. A, Hershberger, E., Amodio-Groton, M. I, Lamp, K. C (2009). Safety and Clinical Outcomes when Utilizing High-Dose (>=8 mg/kg) Daptomycin Therapy. The Annals of Pharmacotherapy 43: 1211-1219 [Abstract] [Full Text]  
  • Musta, A. C., Riederer, K., Shemes, S., Chase, P., Jose, J., Johnson, L. B., Khatib, R. (2009). Vancomycin MIC plus Heteroresistance and Outcome of Methicillin-Resistant Staphylococcus aureus Bacteremia: Trends over 11 Years. J. Clin. Microbiol. 47: 1640-1644 [Abstract] [Full Text]  
  • Moise, P. A., Smyth, D. S., Robinson, D. A., El-Fawal, N., McCalla, C., Sakoulas, G. (2009). Genotypic and phenotypic relationships among methicillin-resistant Staphylococcus aureus from three multicentre bacteraemia studies. J Antimicrob Chemother 63: 873-876 [Abstract] [Full Text]  
  • Pea, F., Furlanut, M., Negri, C., Pavan, F., Crapis, M., Cristini, F., Viale, P. (2009). Prospectively Validated Dosing Nomograms for Maximizing the Pharmacodynamics of Vancomycin Administered by Continuous Infusion in Critically Ill Patients. Antimicrob. Agents Chemother. 53: 1863-1867 [Abstract] [Full Text]  
  • Rehm, S., Campion, M., Katz, D. E., Russo, R., Boucher, H. W. (2009). Community-based outpatient parenteral antimicrobial therapy (CoPAT) for Staphylococcus aureus bacteraemia with or without infective endocarditis: analysis of the randomized trial comparing daptomycin with standard therapy. J Antimicrob Chemother 63: 1034-1042 [Abstract] [Full Text]  
  • Forouzesh, A., Moise, P. A., Sakoulas, G. (2009). Vancomycin Ototoxicity: a Reevaluation in an Era of Increasing Doses. Antimicrob. Agents Chemother. 53: 483-486 [Abstract] [Full Text]  
  • Rybak, M., Lomaestro, B., Rotschafer, J. C., Moellering, R. Jr., Craig, W., Billeter, M., Dalovisio, J. R., Levine, D. P. (2009). Therapeutic monitoring of vancomycin in adult patients: A consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm 66: 82-98 [Full Text]  
  • Rehm, S. J., Boucher, H., Levine, D., Campion, M., Eisenstein, B. I., Vigliani, G. A., Corey, G.R., Abrutyn, E. (2008). Daptomycin versus vancomycin plus gentamicin for treatment of bacteraemia and endocarditis due to Staphylococcus aureus: subset analysis of patients infected with methicillin-resistant isolates. J Antimicrob Chemother 62: 1413-1421 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»